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Appendix C Summit Strategies and Actions The following summarizes proposed strategies developed by participants at the Institute of Medicine's Health Professions Education Summit held in June 2002 to integrate the core set of competencies set forth in this report into health professions education. These strategies address distinct but overlapping groupsoversight experts, health care academic and practice leaders, health professions faculty, and researchers and apply to all disciplines. The committee reviewed the ideas that emerged from the seven interdisciplinary groups at the summit and identified the following five cross-cutting strategies: Define a common language and core competencies across the professions. Integrate the core competencies into oversight processes (accreditation, licensing, and certification). Motivate and support leaders, and monitor the progress of the overall reform effort. Develop evidence-based curricula and teaching approaches as they relate to the core set of competencies. Develop faculty as teaching/learning experts in the core set of competencies. The committee carefully considered the ideas generated by the 150 expert participants at the summit in developing this follow-up report and its recommendations. 156

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APPENDIX C B , The following sections present an overarching vision developed by the committee for each of these proposed strategies and a specific articulation of the strategy by individuals in the respective summit group. Actions are also presented, most at the national level, that represent ways the strategies could be implemented by one or more participants in each group. Finally, select institutional-level actions, developed by individuals from the listed organizations are included for illustrative purposes. 157

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HEALTH PROFESSIONS EDUCATION DEVELOP A COMMON LANGUAGE AND CORE COMPETENCIES Vision Across hea1/tth professions schools andpractice environments, there is a shared definition of key terms and competencies for educating health care professiona1/ts. Whi1/te the ro1/tes of individua1/t health professiona1/ts vary with respect to each of the competencies, these shared def nitions transcend occupations and enab1/te cross- discip1/tinary communication. They enable interdiscip1/tinary groups to define and reach consensus around a core set o, f competencies, for health pro, Cessions education. Proposed Strategy The health professions should collectively take deliberate steps to build consensus around common terms and competencies. Proposed Actions Initiate a formal process, involving a broad cross section of disciplines, to identify areas of agreement and those that are sensitive or taboo. Also, identify how terms are used in the literature, oversight processes, law, and policy. Write a paper identifying related issues. . Engage key stakeholder professions in understanding the problems and related issues associated with the lack of a common language. Create an interdisciplinary group to develop a common language. Define commonalities with respect to competencies across professions, and capture in a report. 158

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APPENDIX C The common language and common competency working group included representation from: Alliance for Continuing Medical Education American Nurses Association, Division of Nursing Case Western Reserve University, School of Nursing Colorado Chapter of the Federation of Families for Children's Mental Health East Central University Grace Episcopal Church . Health Resources and Services Administration, Office of Rural Health Policy Intermountain Health Care Inc., Clinical Support Services The Johns Hopkins University Hospital, Nurse Administration, GYN/OB Mayo Clinics Department of Nursing National Network of Health Career Programs in Two-Year Colleges University of Missouri-Columbia, School of Health Professions . Selected Institutional Actions University of Texas, M.D. Anderson Cancer Center, Nursing Practice and Policy Yale University, Managed Behavioral Health Care, Department of Psychiatry Contact National Board for Certification in Occupational Therapy (NBCOT) to brief them on summit objectives and discuss possible future role University of Texas, M.D. Anderson Cancer Center contact office of nursing services for nominees for group focused on developing common language and survey Texas Medical Center leadership for how to link this effort to professional partnership project. Alliance for Continuing Medical Education, Colorado Chapter of the Federation of Families for Children's Mental Health, National Network of Health Career Programs in Two Year Colleges, create a list of individuals to participate on the interdisciplinary team charged with developing common competencies. 159

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HEALTH PROFESSIONS EDUCATION INTEGRATE CORE COMPETENCIES INTO OVERSIGHT PROCESSES Vision There is consistency in approach and coordination across the various hea1/tth professions oversight organizations inc1/~ding accrediting, 1/licensing and certification bodies as the resu1/tt of a focus on an agreed-upon set of core competencies. This consistency a1/~1/tows for enhanced communication, integration, and synergy within and across oversight bodies andprofessions. As a resu1/tt, educationa1/t programs are eva1/~uated based on outcomes, and a c1/tinician's competency is assessed upon entry into practice and regu1/lar1/ly throughout his or her career. - Proposed Strategy The TOM should convene accreditation, licensing, and credentialing organizations across the spectrum of health professions to move all health professions to competency-based oversight that incorporates the five core competencies. Proposed Actions Establish communication links among regulators. Define accreditation standards and measurements for the core competencies. Share best practices across professions. Request the addition of the competencies to licensing exams. Develop model oversight processes related to the competencies. The oversight process working group included representatives from: AcademyHealth Accreditation Council for Continuing Medical Education 160 Accreditation Council for Graduate Medical Education Alliance of Community Health Plans

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APPENDIX C American Association of Colleges of Nursing American Board of Internal Medicine American College of Clinical Pharmacy American Council on Pharmaceutical Education American Osteopathic Association Association of American Medical Colleges, Educational Standards Baton Rouge General Medical Center, Family Medicine Residency Program Baystate Medical Center Center for Clinical Improvement, Vanderbilt University Charles R. Drew University of Medicine-Los Angeles, Dean's Office/ Academic Affairs Citizen Advocacy Center Commission on Accreditation of Allied Health Education Federation of State Medical Boards of the United States, Inc. The George Washington University, Department of Health Policy Harvard School of Public Health Holy Cross Hospital, Continuing Medical Education Joint Commission on Accreditation of Healthcare Organizations . National Association of Boards of Pharmacy, Washington State Board of Pharmacy National Board of Medical Examiners National Council of State Boards of Nursing National Institute for Standards in Pharmacist Credentialing . National Organization for Associate Degree Nursing National Organization of Nurse Practitioner Faculties North Carolina Board of Nursing People's Medical Society School of Nursing, Vanderbilt University The Robert Wood Johnson Foundation, Communications DepaWnent . Donald W. Reynolds Department of Geriatrics, University of Arkansas Medical Sciences University of Washington, MEDEX Selected Institutional Actions Develop National Council of State Boards of Nursing model regulations for quality improvement competencies. Work on developing and defining standards for quality improvement for practicing pediatricians as part of maintenance of certification at the American Board of Pediatrics. Request the addition of informatics competencies to the pharmacy licensing exam by the National Association of Boards of Pharmacy. Joint Commission on Accreditation of Healthcare Organizations advocate and participate in a meeting of regulators across the health professions. Federation of State Medical Boards work with the National Board of Medical Examiners to incorporate patient-centered care skills into the United States Medical Licensing Exam. 161

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HEALTH PROFESSIONS EDUCATION Motivate And Support Leaders And Monitor Progress Of Reform Effort Vision An interdiscip1/tinary group of education 1/leaders from practice environments and academic and continuing education settings, and inc1/~ding students works to create a shared mission and vision for hea1/tth professions education that re1/lates to but is 1/larger than the five competencies. This reform-minded group monitors progress made on integrating the competencies into hea1/tth professions education andprovides a regu1/lar status report to the 1/larger education and qua1/tity communities. The group a1/tso supports 1/leadership training for education 1/leaders, recognizes and rewards 1/leaders who make a significant contribution to educationa1/t reform, and continuously assesses changing ski1/~1/t needs for hea1/tth professiona1/ts. 1=_ Proposed Strategies ~ - a = ~ The TOM should convene a council of national educational leaders in academic and practice settings, as well as leading consumer advocacy organizations, to develop a joint agenda related to leadership and the overarching vision of a prepared health professional, and to monitor progress against this . . vlslon. The health professions should collectively identify funds that can be used to foster and support partnerships between education and practice leaders with regard to the overarching vision of a prepared health professional. Proposed Actions Develop and make use of fact sheets and case studies that make the case for the overarching vision and the need for reform of health professions education. Promote the overarching vision to the leadership of key organizations. Monitor, evaluate, and communicate progress against this vision by examining efforts to integrate the core competencies into health professions education, including the extent to which summit participants fulfill their commitments. Make the case to sponsors for funding of the council, leadership development activities, and partnerships between academic and practice leaders. 162

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APPENDIX C | . Create and support leadership development skills programs, including efforts to link academic and practice leaders. Create and fund fellowships for formal leadership courses. Charge the IOM to create a national award related to implementation of the overarching . . vlslon. The leadership and monitoring progress working group included representation from: American Nurses Association The Johns Hopkins University American Board of Internal Medicine Kaiser Permanente Foundation Kansas University School of Nursing American Organization of Nurse Massachusetts General Hospital Executives National Association of Community American Pharmaceutical Association Health Centers American Psychological Association National Association of Hispanic Nurses Association of Academic Health Centers National Center for Healthcare Association of Schools of Allied Health Leadership Professions . The Robert Wood Johnson Foundation, Center for Innovation in Public Mental Executive Nurse Fellows Program Health, University of South Carolina National Committee for Quality College of Nursing, University of Iowa Assurance . Continuing Medical Education, . School of Nursing, Duke University Greensb 0 ro Area Health Education Sch 0 ol 0 f Nursing, Oregon Health Center Sciences University Department of Family and Preventive School of Nursing, University of Medicine, University of Utah School of Michigan Medicine St Cloud State University Department of Nursing and Patient Services, Shands Hospital at the University of Rochester, School of University of Florida Medicine and Dentistry Department of Veterans Affairs, University of Wisconsin Hospital and Veterans Health Administration Clinics, University of Wisconsin Medical School Drugay and Associates Vanderbilt Medical Center General Electric Co. Virginia Commonwealth University Grantmakers in Health Wake Area Health Education Center, Healthcare Education Industry University of North Carolina Chapter Partnership, Minnesota State Colleges and Universities John A. Hartford Foundation 163

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HEALTH PROFESSIONS EDUCATION Selected Institutional Actions . National Association of Community Health Centers provide leadership development related to integrating the summit vision of health professions education into community health cen- ter boards. National Center for Healthcare Leadership revise graduate and continuing education curric- ula to be consistent with the vision in the Quality Chasm report (Institute of Medicine, 2001). Implement new skills in experiential learning and in continuing education for pharmacists at the Area Health Education Center in Wake, North Carolina. Minnesota Healthcare Education Industry Partnership convene a working group on imple- mentation of the overarching summit vision. Create a coalition of all five University of Iowa health science deans, chief executive offi- cers of hospitals and hygienic laboratories, and provosts to develop state-level legislative strategies to support the summit's overarching vision. 164

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APPENDIX C Develop Evidence-Based Curricula And Teaching Approaches Vision A rich, readi1/ly avai1/lab1/te evidence base exists to make the case for teaching the five competencies to hea1/tth professions students and c1/tinicians, demonstrating the strong re1/lationship between these competencies and enhanced qua1/tity outcomes for patients. This evidence base is integrated across ad the hea1/tth professions through 1/linkages to profession-specific databases. In addition, those who instruct and mentor hea1/tth professiona1/ts in both academic and continuing education settings have access to a we/ -deve1/toped evidence base regarding the effectiveness of teaching methods and a continuously updated best-practices database. i `;;;65; :~135s ' Add 34` DISC,`` Proposed Strategies Educate health professional groups to focus on the link between health professions education and quality. Activate health professional groups to create and fund a new organization whose research efforts are focused on evidence-based education and the five competencies. Proposed Actions Promote the link between education and quality within leading health professional organizations. Key medical organizations focus on this link as an important issue; begin by writing an editorial to make the case. Association of Academic Health Centers or National Academies of Practice bring health educational professionals together to address the redesign of education, specifically organizational structures. Ask the National Quality Forum to examine the relationship between education and quality. Strengthen the focus of fellowships on the overarching vision defined by the TOM committee. 165

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HEALTH PROFESSIONS EDUCATION | . Investigate/identify information systems that support evidence-based education. Establish an Interdisciplinary Health Professional Education organization, supported by key stakeholders, to identify and evaluate education models that further the overarching vision, function as a repository of related data, and disseminate best practices. This organization should: - Demonstrate the importance of education by focusing on compelling examples in which educational interventions have made a difference to patient outcomes (e.g., wrong-side surgeries, diabetes). - Perform a systematic review of the literature (e.g., best evidence in medical education or best-evidence medical practice, and determine a future research agenda, looking to the Agency for Healthcare Research and Quality. - Conduct a best-practice review of universities that have integrated the five competencies into their curricula to understand what they do and how/why it is a best practice. - Create a database of best practices in health professions education. - Develop research coliaboratives among institutions to demonstrate the effectiveness of the five competencies in both academic and continuing education settings. - Assess the interest among the leadership of the American Academy of Family Physicians in hosting a symposium as part of the research agenda-setting process. The evidence base and curricula development working groups included representation from: ABIM Foundation Health Resources and Services Administration, Division of Medicine AcademyHealth and Dentistry, Bureau of Health American College of Healthcare Professions Executives New Jersey Medical School, University American College of Physicians of Medicine and Dentistry of New . . . . Jersey, Division of Adolescent and American Hospital Association . . Young Adult Medicine American Society of Internal Medicine North American Assoc~ahon of Medical Cedars Sinai Medical Center Education and Communication Community College of Philadelphia, Companies Department of Nursing Nurse Practitioner Faculty Council on Graduate Education Oregon Health and Science University, School of Medicine Brighton University, Office of Interprofessional Education The Robert Graham Center: Policy Florida State University, College of Studies in Family Practice and Primary Medicine Care 166

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APPENDIX C University of Arizona, Arizona Health Sciences Center, College of Pharmacy University of Iowa, College of Nursing University of Maryland, Department of Medical and Research Technology, School of Medicine . University of Massachusetts, School of Nursing University of Missouri, School of Medicine Veterans Health Administration, Department of Veterans Affairs Veterans Health Administration, National Center for Patient Safety Selected Institutional Actions For the American College of Physicians, American Society of Internal Medicine, project on Training for Quality and Evidence Base, stimulate and write educational articles for publication in Annals of Internal Medicine. . North American Association of Medical Education and Communication Companies (NAMMEC), with support from the NAAMEC Board, develop a research project proposal focused on creating a model for evaluating the effectiveness of continuing medical education, carry out the project, and then disseminate results at meetings and in publications. Robert (Jraham (:enter: Policy Studies in Family Practice and Primary Care approach the Agency for Healthcare Research and Quality, the National Science Foundation, Health Resources and Services Administration, and foundations about sponsoring a symposium to develop a research focus on interdisciplinary education. Creighton University, Office of Interprofessional Education, design and conduct an interdisciplinary collaborative research project on effective evaluation of interprofessional education. Texas Tech University Health Sciences Center, School of Nursing, identify specific content for an interdisciplinary curriculum through a survey of faculty in various professions at Texas Tech. Center for Health Policy and Workforce Research, Towson University, hold a follow-up meeting with Towson University leadership to identify resources and plan the development of new centers and cross-professional activities. University of Alabama at Birmingham (UAB), School of Health Related Professions, create a center or office for health professions education and workforce development at UAB. Samford University, McWhorter School of Pharmacy, distribute a "Samford Plan" (continuous quality improvement process model for curriculum development and refinement) to all summit participants. 167

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HEALTH PROFESSIONS EDUCATION Develop Faculty As Teaching And Learning Experts Vision Facu1/tty deve1/topment programs exist at the nationa1/t and regiona1/t 1/teve1/ts for the array of hea1/tth professional/ educators, focused on the overarching vision presented in this report. The programs, many of which are interdliscip11tinary, prepare faculty to convey the five competencies, as we1/~1/t as to adopt an evidence-based approach to education. ~_~ Proposed Strategy Health professional groups should motivate and enable faculty in their efforts to implement the overarching vision of a prepared health professional. Proposed Actions Identify cross-cutting faculty competencies. Ilelp organize an inventory of best practices and resources for faculty development. Create a program to recognize "educational scholars" on a national basis, and promote the program to health professional schools. Develop and disseminate online self-instructional lessons/courses in faculty development related to the overarching vision. Help develop models for reform of criteria for promotion and related compensation, including tenure models, starting initially in the field of pharmacy. The faculty development working group included representation from: American Association of Colleges of Pharmacy Community College of Philadelphia, Department of Nursing Health Resources and Services Administration Michigan State University National League for Nursing New York University, School of Medicine . Southern Regional Education Board, Council on Collegiate Education for Nursing University of Colorado Health Sciences Center, Office of Education University of Washington, School of Medicine Virginia Commonwealth University, School of Nursing 168

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APPENDIX C Selected Institutional Actions School of Medicine, New York University, assess existing quality improvement processes for education as part of an effort to achieve consensus on a quality improvement model for all of health professions education. Council on Collegiate Education for Nursing, Southern Regional Education Board (SREB), conduct a validation study of expected competencies for nurse educators in 16 SREB states. American Association of Colleges of Pharmacy help organize an effort to inventory best practices and resources for faculty development. Virginia Commonwealth University provide information technology orientation for new faculty. Michigan State University work with a national professional training organization and the Association of Program Directors in Internal Medicine to begin to develop online self- instruction in faculty development. 169